Irene J. Elkins

Background: We examined whether increased risk for adolescent tobacco and marijuana problems associated with childhood ADHD is explained by key intermediary influences during adolescence and differs by gender. Methods: Longitudinal structural equation models examined mediating effects on problems with both substances (or each substance separately) through age‐14 peer impairment, internalizing, and adolescent ADHD symptoms in two twin samples, prospectively assessed since age 11 ( N = 2,164). Whether these mediators contributed beyond mediating effects of early‐adolescent substance use was also considered. Twin difference analyses further illuminated which mediators might be potentially causal. Results: Direct effects of childhood ADHD on age‐17 tobacco and marijuana problems (i.e., independent of included mediators) as well as effects of adolescent ADHD symptoms were significant only for females. By contrast, mediation by peer impairment, evident particularly for marijuana, was relatively stronger for males than females. Depression and anxiety were not prospectively associated with age‐17 substance problems when earlier substance problems were considered. Consistent with causal influence of early substance use on later problems, monozygotic twins with more severe tobacco or marijuana problems at age 14 than their co‐twins were also more likely to have substance problems later in adolescence. Conclusions: Mediation through peer impairment, continued presence of ADHD symptoms, and early substance use may alter development so that childhood ADHD indirectly contributes to problems with tobacco and marijuana. Targeting gender‐sensitive interventions prior to mid‐adolescence, before these patterns become established, is essential.

Objective:This study examined the effects of childhood attention deficit hyperactivity disorder (ADHD) symptoms, both inattention and hyperactivity-impulsivity, on the development of smoking in mal...

Whether gender differences exist in the impairment associated with attention-deficit/hyperactivity disorder (ADHD) is still largely unknown, because most samples have few affected girls or include only one sex. The current study evaluated whether ADHD affects adjustment differently for girls than boys in a population-based cohort of 11-year-olds (520 girls, 478 boys). Those with a DSM-IV diagnosis of ADHD (predominantly inattentive, hyperactive-impulsive, or combined) were compared to those without ADHD on teacher, parent, and child reports of academics, peer relationships, self-concept, clinical symptoms, and treatment. Although boys and girls with ADHD experienced difficulties in all areas, girls with ADHD, especially the inattentive subtype, were more negatively affected in academics and peer relationships. Inattentive girls were less popular and more likely to be bullied than girls without ADHD, whereas inattentive boys were not. The social isolation experienced by many girls with ADHD deserves greater attention.